Brain Zaps:
Research Findings of A. Papp, MD
Introduction to Brain Zaps
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Alexander Papp, MD, is the primary author of two peer-reviewed papers on brain zaps, which is the colloquial name for brief electrical sensations commonly experienced during antidepressant discontinuation. Both papers were co-authored with Julie A. Onton, PhD, a researcher at UC San Diego. Published in the Primary Care Companion for CNS Disorders in 2018 and 2022, they represent the most systematic published examination of this symptom to date. Dr. Papp collected the original data and led both publications; both articles are freely available to the public.
What Are Brain Zaps?
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Brain zaps are sensations described as brief electrical shocks or jolts perceived as occurring inside the head. They are most commonly reported by patients who have stopped taking antidepressants or reduced their antidepressant medication dose, and they can be accompanied by vertigo, brief auditory phenomena (including the unusual sensation of “hearing one’s eyes move”), and momentary disorientation. Despite being a recognizable and sometimes disabling symptom, brain zaps received little systematic attention in the psychiatric literature before Dr. Papp’s work.
Summary:
Brain Zaps: An Underappreciated Symptom of Antidepressant Discontinuation
by Papp A, Onton JA. Triggers and Characteristics of Brain Zaps According to the Findings of an Internet Questionnaire. Prim Care Companion CNS Disord. 2022 Feb 10;24(1):21m02972. Free full text
This paper analyzed 595 unsolicited posts from a lay mental health website, examining 378 statements from individuals describing symptoms during antidepressant discontinuation. The goal was to document, for the first time in a systematic way, the characteristics of brain zaps as reported by the people who experience them.
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Key findings included:
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Venlafaxine and paroxetine were disproportionately represented relative to their prescribing frequency, consistent with the known greater withdrawal burden of shorter half-life antidepressants. Fluoxetine, a longer half-life medication, was less frequently mentioned.
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Abrupt discontinuation was the most common precipitant, but gradual tapering provided only partial protection — brain zaps occurred even with proper tapering.
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While brain zaps were transitory for most patients, a small number reported significant disability lasting months or years, with no effective treatment available.
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An unexpected and previously unreported finding was the frequent association of brain zaps with lateral eye movements, which emerged as the most commonly described trigger.
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Many patients reported being unable to obtain meaningful help from their prescribers, and some expressed frustration that the symptom was dismissed or unknown to the clinicians they consulted.
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Summary:
Triggers and Characteristics of Brain Zaps According to the Findings of an Internet Questionnaire
by Papp A, Onton JA. Triggers and Characteristics of Brain Zaps According to the Findings of an Internet Questionnaire. Prim Care Companion CNS Disord. 2022 Feb 10;24(1):21m02972.
Drawing on the same dataset, this follow-up paper used a structured internet questionnaire — gathering 3,141 responses between 2016 and 2018 — to allow for more systematic analysis, including the first statistically confirmed findings on brain zap characteristics.
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Key findings included:
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The correlation between antidepressant half-life and the time to onset of the first brain zap was statistically significant — described in the paper as the first time this link had been formally established. Shorter half-life medications (paroxetine, venlafaxine) produced earlier onset; longer half-life medications (fluoxetine, vortioxetine) showed considerably longer latency.
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Lateral eye movement as a trigger was confirmed with greater clarity, with over 1,000 of 1,669 respondents who identified a trigger pointing to eye or head movements — reported in open-ended responses, without prompting.
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Restarting the original antidepressant was the most reliably effective approach to resolving brain zaps. Switching to a serotonergic antidepressant with a longer half-life (particularly fluoxetine) was the next most effective strategy; nonserotonergic agents such as bupropion were largely ineffective.
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For 17% of respondents, the impact on quality of life was overwhelming. respondents were still experiencing brain zaps at the time they completed the questionnaire.
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The paper recommends that brain zaps be added to the standard Discontinuation Emergent Signs and Symptoms Scale (DESS), which currently does not include them despite their clinical significance.
Clinical Implications
Taken together, the two papers establish that brain zaps are a real, identifiable, and sometimes serious symptom of antidepressant discontinuation — not a vague subjective complaint. They have consistent characteristics, a biologically plausible mechanism linked to medication half-life, and a reliably reported trigger in lateral eye movements that may eventually support objective investigation of the underlying pathophysiology.
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Dr. Papp’s research also informs how he responds to patients who feel dismissed by prior providers. The data show that patients with brain zaps frequently encountered clinicians who were unaware of the symptom or minimized it. He takes care to validate the experience as a recognized physiological phenomenon rather than a functional complaint, which he finds improves patient trust and engagement in the tapering process.
IIn clinical practice, Dr. Papp now now routinely informs patients about the possibility of brain zaps before initiating antidepressant treatment, particularly with shorter half-life agents such as paroxetine and venlafaxine. He discusses the likelihood, typical duration, and potential severity of the symptom as part of the informed consent process for starting these medications.
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When a patient presents with brain zaps, Dr. Papp finds it useful to ask specifically whether lateral eye movements trigger the sensation. A positive answer is a strong indicator that what the patient is describing is a true brain zap rather than another neurological symptom, which can help avoid unnecessary referrals or investigations.
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For patients experiencing brain zaps after discontinuation, Dr. Papp’s approach prioritizes restarting the original antidepressant at a low dose and then tapering more gradually if discontinuation remains the goal. When restarting is not appropriate, switching to fluoxetine ( — a longer half-life serotonergic agent with a longer half-life), which is — is the strategy most supported by the data from these papers.
Publications
Papp A, Onton JA. Brain Zaps: An Underappreciated Symptom of Antidepressant Discontinuation. Prim Care Companion CNS Disord. 2018 Dec 20;20(6):18m02311. Free full text
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Papp A, Onton JA. Triggers and Characteristics of Brain Zaps According to the Findings of an Internet Questionnaire. Prim Care Companion CNS Disord. 2022 Feb 10;24(1):21m02972. Free full text
Learn More
For more on Dr. Papp’s background and clinical approach, visit his provider page.
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For information on psychiatry services at Point Loma Clinic, including medication management and psychopharmacology consultations, visit the Psychiatry page.
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This is the second white paper published by Point Loma Clinic providers. The first was Ketamine Treatment in Psychiatric Practice: An Evidence-Based Clinical Overview — was authored by Dr. Alexander Papp and Dr. Julie Myers.
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